Time for action: oxytocin and uterotonics are life-saving AND dangerous.

Abstract

Marx-Delaney, et al have written an excellent article documenting high prevalence of oxytocin misuse and associated adverse outcomes during the intrapartum period in India. They explain how use of the Safe Childbirth Checklist and coaching led to decreased misuse of oxytocin for augmentation and increased use of oxytocin postpartum to prevent postpartum hemorrhage (PPH). Both effects persisted during the six month follow-up period during which coaching ceased. Although encouraging, changes in behavior of women, providers and health systems will be difficult given the long-term cultural acceptance of oxytocin use during labour. In northern India, research between 1983-1989 by Jeffrey (Jeffrey, et al, Labour Pains and Labour Power. London:Zed Books, 1989, 111-112) found that 15% of labouring women received oxytocin from government pharmacists. Similarly, in Van Hollen's 2003 study (Van Hollen C, Medical Anthropology Quarterly, 2003, 17(1), 49-77), providers stated that women did not just ask but demanded oxytocin in southern India.